Available online 6 December 2025

Author links open overlay panel, , , , AbstractObjective

To describe the current state of AAGL-FMIGS fellowship programs, assessing case volume, case types, and differences among programs.

Design

Retrospective cohort study.

Setting

Fellowships in Minimally Invasive Gynecologic Surgery (FMIGS) in the United States.

Participants

All fellows who started and completed an AAGL-FMIGS fellowship in the U.S. between 2020 to 2024.

Results

During the study period, 130 fellows completed a 2 or 3-year fellowship from start to finish among 52 fellowships. The median number of total cases completed in a 2-year fellowship was 510 [IQR 428-586]. The most common procedure was hysterectomy (median 210 [IQR 174-255]), followed by peritoneal procedures, which included retroperitoneal dissection and adhesiolysis (median 125 [IQR 91-167]), and endometriosis procedures (median 89 [IQR 56-132]). The medians for other case types were as follows: myomectomies (including hysteroscopic) 62 [IQR 40-95], adnexal surgeries 39 [IQR 25-67], and hysteroscopies (excluding hysteroscopic myomectomy) 45 [IQR 35-77].

Among the 130 fellows, 67% (n= 87) had FMIGS-trained Program Directors and 33% (n= 43) had non-FMIGS-trained Program Directors. Fellows from programs with FMIGS-trained Program Directors had greater surgical volume compared to fellows with non-FMIGS-trained Program Directors (median number of cases per fellow of 537 [IQR 468-620] vs 464 [IQR 367-551], p=.03). Furthermore, fellows from programs with FMIGS-trained Program Directors compared to those with non-FMIGS-trained Program Directors, completed a median of 108 vs. 58 endometriosis surgeries (p=.01), 71 vs. 44 myomectomies (p = .01), 52 vs. 39 hysteroscopies (p=.06), and 215 vs. 187 hysterectomies (p=.27), respectively.

Conclusion

Adopting the ACGME case log system provided greater insight into the volume and types of cases completed in AAGL-FMIGS programs. Overall, AAGL-FMIGS programs have robust surgical volume with Program Director training affecting volume and case types. Fellows from programs with FMIGS-trained Program Directors have significantly greater total case volume, myomectomies, and endometriosis surgeries.

Introduction

The Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) associated with the American Association of Gynecologic Laparoscopists (AAGL) was established in 2001. Over the past 20+ years, the number of AAGL-FMIGS fellowship programs and graduated fellows across the nation has continued to grow, and currently, AAGL-FMIGS is a competitive fellowship after residency in Obstetrics and Gynecology (1). The primary focus of AAGL-FMIGS fellowships is to train high volume gynecologic surgeons who can manage complex benign gynecologic conditions on a subspecialty level. Ideally, all surgical fellowships will offer large case volumes and high case complexity when training fellows; however, variability between surgical training programs exists. In February 2020, AAGL-FMIGS transitioned from a homegrown case log system to the Accreditation Council for Graduate Medical Education (ACGME) system. With the transition to the ACGME system, we were able to capture case volume more accurately and case types more comprehensively, as fellows could log any case with a Current Procedural Terminology code, rather than only those on the case minimum list, allowing us to better understand the existing FMIGS fellowships. The primary objective of this study is to describe the current state of AAGL-FMIGS fellowship programs, specifically describing the case volume, case types, and differences among fellowships over the past 4 years.

Section snippetsMethods

This is a retrospective cohort study conducted between July 2020 to October 2024. All fellows who initiated and completed their AAGL-FMIGS training between 2020 to 2024 were included in this study. Fellows who graduated from a 3-year fellowship in 2022 were excluded since they started fellowship in 2019 before the transition to the ACGME system. In addition, fellows who completed programs outside the United States were also excluded. All fellows and fellowship programs were assigned a unique

Fellowship demographics

Between July 2020 to October 2024, there were 52 AAGL-FMIGS programs in the U.S. that graduated 130 fellows. Among the 52 fellowships, 51 offered 2-year fellowships and graduated 128 fellows, and 1 offered a 3-year fellowship and graduated 2 fellows during the study period. Geographically, 36% (n=19) of fellowships were in the Northeast, 33% (n=17) in the South, 15% (n=8) in the Midwest and 15% (n=8) in the West.

There were a total of 52 Program Directors and 79 Assistant Program Directors.

DISCUSSION

The transition from the prior AAGL-FMIGS case log system to the ACGME system in 2020 permitted more comprehensive and accurate logging, enabling a better assessment of the current state of AAGL-FMIGS fellowships. While FMIGS has been established for over 20 years, this is the first study to describe the demographics of the fellowships, surgical volume, types of cases, indications for surgery, and differences among programs.

The primary focus of AAGL-FMIGS is to train high volume surgeons who can

Prior Presentation

This study was presented as an oral abstract presentation at the AAGL 53rd Global Congress in 2024 and was awarded the Jordan M. Phillips Award for best abstract on MIGS.

IRB approval

This study was exempt from the IRB.

Declaration of competing interest

none

Funding

none

References (6)

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